Cervical Pap screening among Israeli women, 2005-2010

Purpose: This study describes the distribution and the trends of cervical abnormalities in Israel, based on Pap smear results. Methods: A retrospective analysis of cervical smears received by the Central Pathology Laboratory of Maccabi Healthcare Services between January 2005 and December 2010. Results: In total, 711,541 Pap smears were screened in the study period. Cytological abnormalities were observed in 4.78 % of the total smears screened. An increase was observed in the rate of positive results from 2.63 % in 2005 to 6.78 % in 2010 (p = 0.0026). The cervical abnormalities in the study period distributed as follows: atypical squamous cell (ASC) - 2.72 %, low-grade squamous intraepithelial lesion (LSIL) - 1.54 %, high-grade squamous intraepithelial lesion (HSIL) - 0.34 %, squamous cell carcinoma - 0.01 %, atypical glandular cells (AGC) - 0.10 %, adenocarcinoma in situ (AIS) - 0.06 % and invasive adenocarcinoma - 0.01 %. The increase was statistically significant for ASC (p = 0.0028), LSIL (p = 0.0069) and for HSIL (p = 0.0260). The mean ages at diagnosis of women with ASCUS, LSIL, HSIL, squamous cell carcinoma, AGC, AIS and adenocarcinoma were 37.8, 33.2, 38.6, 55.4, 41.1, 49.9 and 57.1 years, respectively. Conclusions: The increase in the rate of squamous cell abnormalities demonstrated in this study emphasizes the need of implementing an education and a screening program among Israeli women. HPV vaccine, sexual behavior, cytology performance and HPV test are primary and secondary prevention tools which may reduce morbidity and mortality in the future. In addition, based on the age at diagnosis of the different pathologies, the age group in which Pap test is performed in Israel should be expanded from 35-54 to 25-65 years.